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APPLICATION FOR SANITATION PERMIT Permit No. t li D [Complete in upcae)+ .Z, t Date Issued Applica;ion is hereby made to the San Joaquin Local Health District for a pe'mit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. 1 - JOB ADDRESS A LOCATION--------------------- ____.___ _- ----- ---------- - -- /� r . { ------------------ Phone-_-/-- Owners Name_-_. __►�'±-�".�'�,-------;, �----- ------------••-----•- , /— i r! � ---------------------------------------- Add ress------•------ Contractor's Name-----.------------------ -- _---- qr J Installation will serve: iResidence ,�i.�/,A/rlartment House [I Commercial ❑ Trailer Court El Motel El Other ❑ ' K, r' t , 1 9 e� aths ---/--- Lot size `� 'V r .U--------- -• -- ---------- Number of living uni#s: .------ N .mber of bedrooms _- -____ Number of b r � r Water Supply:"Public system Community system-E] ❑ Deih to Water Tableft¢ Character of soil to a depth of 3 feet: Sand . Gravel E] Sandy Loam Q Clay Laa. [j Clay E] Adobe( rdpan ElE] Previous Application Made:' Yes E] No 2--7-New Construction: Yes El No e TYPE OF INSTALLATION, AND SPECIFICATIONS: I (No septic.tank'or cesspoolpermitted if public sewer is available within 200 feet.) Septic Tank: #Distance fromanearest well___.-__-.--- 'Distance from foundation___________________.Material__________.-____________________"-_,_-_____._. 0No.of,compartments-------------- ------size---------------•-------- Liquid depthCapacitY 9- iF Disposal Field:- Distance from nearest well_________________Distance from foundation--_-----_-_----_----Dis#ante to ,aeras+ lot line-------.._______. Number of lines------------- -------------------Length of each line--------- - Width of french = ❑ t „TYpe of filter material ------------------------- -Depth of filter material-----------.------i----Total length--------------------------------•--------- 3 ..:....: .:a w. _ Seepage Pit: Distance to nearest well- __._-_Distant f o fouation____�p______.Dista,fe to nearest lot line;___ �_�__ Number of pits.._.___-----------_Lining material_`�I-Size:Diameter--�1-0T..______..Depth..______.______ 1 r r . -..- . i$ Cesspool: Distance,from nearest well-----------------Distance from foundation-----_--------------Lining material--___._____________.___-___:_______. _--Li Liquid Capacity -_ al$. ❑ Size: Diameter Depth -- ------- q p Y ' ' 9 : Distancefrom3nearest well- -- --- - ---=----pistance,from nearest building_ _ -_ --------------- --Privy'!❑ ..,, _,.. Distance +o nearest lot line_-- IK Remodeling and/or repairing (describe): - , -- -----• =k( _- ------- - ---------------------- _______________ _______.--------------------------------------+r4_ _ _--. ____9 -_ _ ---_-__ ---. ---.----__-----------_ _ -------_----_ f _________________________________________ I ' Fhereby certify that 1-have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la .s' and rules-and regulations of the San Joaquin Local'Health District. r Contract ` '"""'- ------------------ ---------Owner and/, or) (Signed)---------- - ; --------------------------------------�_#--------------------(Tit .- - --- BY: le)_. (Plot plan, showing size'-of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). R J .J FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---------------------------- ---- --- -----------------•---•---------.- DATE---------- --- ---- -------------- t _ ► I = '= DATE----------------------------------------------------------- REVIEWED BY------------= = -= --- -- ' ; t - -p ' - I ------- DATE-------------------- --------------------------------------- BUILDING-PERMIT ISSUED_______________'___._,_____._ _. --------------------------------------------- A_ Alterations and/or recommendations:----A-----` '------ -----------------------------------�-' •------------------------------- ». i _ ----------------------------- -------------------------------•-------------------------------------, �' -------------•-------- ----------------•------•--------------------------------------------•----------------------- •--------------------------------------------------- } - -------------------------------------------------------------------------- ------------------------------------------------------------ - --------------------------•----•-----------------------•----------- ---- --------------------- --------------- ---------•---------- ------------------------------- ------------------- Date: --------------- - INSPECTION-BY:-------- - _ - _----- -- Date:-----'------ '= .""'�_' --' -------------------------- FINAL— SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES--9-2M : Revised W-2100 r __-